Poland

2005: Home care

Legislation relating to the provision of home care services

During the Communist era, there was a comprehensive programme of health care benefits organised and provided by the State. In 1999, the Health Insurance Act introduced an obligatory health insurance system. Membership of a health insurance fund is now compulsory and citizens pay a tax-deductible premium of 7.5% of their personal income.

Direct reference to “care of the elderly” can be found in article 2, point c of the Act on Social Care of 1923. The new Act on Social Care of 1990 does not contain a specific reference to care of the elderly. Nevertheless, it is stated in article 3 of the new law that social assistance is granted to people and families in particular situations e.g. in case of disability and/or prolonged sickness. Disability is defined in article 2a as “a physical, psychical or mental state causing a lasting or periodical restriction of independent existence”.

Children are legally obliged to provide for their elderly or disabled parents and this can be enforced in court if necessary. According to article 908 of the Civil Code, a person can make an agreement with someone to exchange the ownership of property for help and nursing in case of sickness (Dz.U. 64.16.93)

The right to receive care can be found in article 17 of the Act on Social Care (Dz.U. 98.64.414) which states that “1. People living alone, who because of age, sickness or other reasons require the help of others, and do not receive it, have the right to help in the form of care services. 2. Care services can be also received by people, who need help, which family cannot provide.”

Article 14, point 3 of the Act on Family, Nursing and Parental Benefits (Dz.U. 98.102.651) grants people over the age of 75 the automatic right to a nursing benefit regardless of their state of health. People over 75 living in institutions are not entitled to this benefit.

Organisation and financing of home care services

Generally speaking, the State policy concerning assistance to the elderly concentrates on financial assistance to those who are the most socially and economically weak which means that the health needs of elderly people on low incomes often go unmet. Benefits and services are also provided on the basis of the level of disability.

The local authorities are responsible for organising social assistance. They do this through Social Care Centres. A variety of services are provided by different organisations Some services, such as washing, bathing and personal hygiene, are performed by health care workers (e.g. community care nurses). Meals are distributed thanks to the Polish Red Cross, the Polish Committee on Social Welfare and NGOs. Some of the meals come from canteens in care homes and schools.

It is stated in article 18 of the Social Care Act that “Care services include help in providing for daily needs, hygiene care, nursing care recommended by a physician and if possible providing social contacts…” Services are also organised and provided through Community Care Centres, which are public institutions. Staff in these centres are responsible for finding people with low incomes in need of assistance. They also organise the provision of care by making contracts with NGOs, private companies and public institutions. Sometimes, the social workers in these centres provide the services themselves but the centres also open their doors to NGOs and self-help groups.

The nursing benefit for people over 75, mentioned in the previous section, is extremely low and would not in fact even cover the most basis needs of nursing care.

Kinds of home care services available

A variety of home care services exist including:

Managing the household

Preventing social exclusion/promoting social integration

Doing small repairs e.g. electrical appliances

Laundry

Transport

Day care centres

Day care centres usually offer 4 to 8 hours of care per day to elderly people. In these centres, the elderly can have a hot meal, take part in various activities and receive care from a nurse. Unfortunately, the number of day care centres is steadily decreasing.